Phase I – Maximum Protection (0 to 1 weeks):

0 to 1 week:

  • Ice and modalities to reduce pain and inflammation
  • Use crutches non-weight bearing for 6 weeks
  • Brace for 6 weeks in full extension
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • Begin full passive/active knee range of motion exercises
  • Quadriceps setting focusing on VMO restoration
  • Multi-plane open kinetic chain straight leg raising
  • Gait training with crutches (NWB)

Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6):

Weeks 1 to 6:

  • Maintain program as outlined in week 0 to 1
  • Continue with modalities to control inflammation
  • Initiate global lower extremity stretching program
  • Begin stationary bike and pool exercise program (when incisions healed)
  • Implement reintegration exercises emphasizing core stability
  • Closed kinetic chain multi-plane hip strengthening on uninvolved side
  • Manual lower extremity PNF patterns
  • Proprioception drill emphasizing neuromuscular control
  • Multi-plane ankle strengthening

Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 10):

Weeks 6 to 8:

  • Modalities as needed
  • Continue with Phase II exercises as indicated
  • Begin partial weight bearing at 25% of body weight and increase by 25% approximately every 3 days. May progress to one crutch at 71/2 weeks as tolerated, gradually wean off of crutches by week 8 – 9

Weeks 9 to 10:

  • Normalize gait pattern
  • Advance stationary bike program; begin treadmill walking and elliptical trainer; Avoid running and impact activity
  • Initiate closed kinetic chain exercises progressing bilateral to unilateral
  • Initiate proprioception training

Phase IV – Advanced Strengthening and Initiation of Plyometric Drills (Weeks 10 to 20):

Weeks 10 to 16:

  • Initiate gym strengthening-beginning bilateral progressing to unilateral
    • Leg press, heel raises, hamstring curls, squats, lunges, knee extensions (30° to 0° progressing to full range as PF arthrokinematics normalize)

Weeks 16 to 20:

  • Continue with advanced strengthening
  • Begin functional cord program
  • Begin pool running program progressing to land as tolerated

Phase V – Return to Sport Functional Program (Weeks 20 to 24):

  • Follow-up examination with physician
  • Implement sport specific multi-directional drills and bilateral plyometric activity progressing to unilateral as tolerated
  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Sports test for return to play

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